This letter from Integra CEO Kevin Welch is in response to the article written by Kapali Eswaran in the September/October 2009 issue of ComputerTalk regarding "What to Look for in a Paperless System."

September 23, 2009

To the editors:

By way of introduction, my company Integra has unique insight into this subject based on our experience with installation of our systems in over 300 LTC/Specialty pharmacies alone over the last several years.  Based on our experience with the installation of these systems in some of the largest pharmacies in the country, the first and foremost questions you need to ask about the vendor and their track record in this industry: 

• Was the system designed for this industry and what do their existing customers in this industry say about them?

• Do they have existing partnerships with other system vendors in order to provide you with well designed and tested interfaces?

• What kind of technology are they using and is it something that you can successfully use for a long time to come?

• Did they develop their system themselves, was it specifically designed for this industry, did they OEM it from someone else and did they use offshore labor to create it?

• What kind of service can they provide and will they contractually commit to specific levels of service?

• Is the vendor you are dealing with aware of the various regulatory issues associated with implementing a paperless system and have they obtained regulatory approval in your state to do so?

The reason these and other similar related questions are important is that in the end your success or failure with such systems will come down to your ability to work with a vendor that has done this before in your industry, who can amortize their development, testing & support costs over a large number of customers in your industry, and who has successfully retained their customers over a long period of time. 

If the vendor you are dealing with does not have an established track record serving this industry, despite the fact of having some success in other related industries (such as acute care or retail pharmacy), then you should think again.  Systems designed for other industry segments do not for the most part handle the various operational and workflow details necessary for their successful use in LTC/Specialty pharmacy - and unfortunately you may not find this out until after you install the system.

One last comment of Eswaran's article - he advocates using the Tagged Image File Format (TIFF) within a paperless pharmacy system.  Unfortunately in this area he is clearly incorrect -both TIFF and PDF (the successor to TIFF) are IEEE standards not controlled by any one vendor; plus TIFF is not HIPAA compliant and cannot be easily made so.  The use of annotations, digital signatures or other such enhancements by a paperless system also renders the TIFF images proprietary.  It was based on these reasons and the fact that many state regulatory agencies will not approve TIFF that several years ago Integra switched to PDF as its primary file format.

In closing, I agree with Eswaran where he states that "moving into the paperless world...is a step you should take only after careful planning and research into which system will provide you with the full set of features that will make your pharmacy truly paperless." Integra would recommend the same.

Kevin P. Welch

Chairman & CEO
Integra